Introduction: Surgery for vulvar malignancies involves large defect, complicating wound healing and postoperative morbidity. However, it remains the mainstay of vulvar malignancy treatment. The prognosis for vulvar cancer is generally good with appropriate management. A multidisciplinary approach is desirable. Case report: A 69 years female presented with complaints of swelling in genital region and occasional bleeding from the mass for 9 months. With World Health Organization (WHO) performance score of 3, stage IIIC squamous cell was diagnosed. Palliative radiotherapy was given, 6 weeks later the primary lesion disappeared but the inguinofemoral mass size remained. With the improved general condition, excision was done (left-sided inguinofemoral lymphadenectomy) with flap grafting (Anterolateral thigh flap). Postoperative recovery was good. An additional 30GyEBRT was well tolerated. Conclusion: Advanced vulvar cancer surgery carries significant morbidity. With low incidence, the level of evidence for treatment of vulval cancer is low too. Reconstructive surgeries have shown reduction in morbidity and improvement in quality of life; but few studies are available evaluating the impact of such surgeries. ALT flap is a versatile perforator flap and hence, is useful in large vulvoperineal defect and large groin defect.